Aida-Isabela Adamescu

Background: Acute infections and antibiotic use remain clinically relevant among people living with HIV (PLWH). This exploratory study assessed self-reported acute infections, usual healthcare contact, antibiotic use, and antibiotic-related knowledge among PLWH. Methods: We conducted a single-center cross-sectional questionnaire-based study among 209 PLWH in Bucharest, Romania (October 2025–March 2026). The questionnaire assessed self-reported acute infections and hospitalizations during the preceding 12 months, usual healthcare contact, antibiotic use, and six knowledge items. Frequent self-reported antibiotic use was defined as use on at least three occasions during the preceding 12 months. Results: At least one self-reported acute infection was reported by 45.5% of participants; 9.6% reported an infection-related hospitalization. The family physician was the most frequently reported usual healthcare contact (55.0%), followed by the infectious diseases physician (31.6%). Among 207 participants with evaluable antibiotic-use data, 22 (10.6%) met the frequent-use definition. In exploratory analyses, knowledge scores were higher among participants with greater educational attainment and those living in urban areas, but showed no clear evidence of an association with frequent self-reported antibiotic use (unadjusted OR per 1-point increase, 1.16; 95% CI 0.88–1.54; p = 0.290). In an exploratory adjusted analysis, self-reported acute infection and suboptimal physician-estimated antiretroviral therapy (ART) adherence were associated with frequent self-reported antibiotic use. Conclusions: Frequent self-reported antibiotic use was associated with reported acute infections and suboptimal physician-estimated ART adherence, whereas there was no clear evidence of an association with antibiotic-related knowledge. This pattern suggests that infectious morbidity and care-related factors may be important correlates of repeated antibiotic use in PLWH and highlights the potential value of coordinated stewardship across HIV and primary care.

Background: The COVID-19 pandemic exposed major vulnerabilities in healthcare accessibility and may have influenced preventive attitudes among people living with HIV (PLWH). However, the relationship between pandemic-related healthcare experiences and vaccination uptake remains insufficiently understood. Materials: A cross-sectional survey was conducted among 203 adults living with HIV receiving follow-up care in Romania between October 2025 and March 2026. The questionnaire evaluated vaccination uptake, vaccine-related perceptions, healthcare information sources, and pandemic-related experiences. Multivariable logistic regression analysis was performed to identify factors independently associated with vaccination uptake. Results: Only 38.9% of participants reported receiving at least one vaccine within the previous three years. The main barriers to vaccination were perceived lack of necessity, lack of physician recommendation, fear of adverse effects, and lack of trust. Multivariable logistic regression identified positive vaccine-related beliefs (OR = 0.454, 95% CI: 0.235–0.876, p = 0.019) and CD4+ T-cell count above 500 cells/mm³ (OR = 0.448, 95% CI: 0.232–0.867, p = 0.017) as independently associated with lower odds of being non-vaccinated. More than half of participants (52.7%) reported at least one pandemic-related disruption or negative health impact. The pandemic-related negative impact composite was not significantly associated with vaccination status (p = 0.209), whereas confirmed COVID-19 infection was more frequent among vaccinated participants than among non-vaccinated participants (43.0% vs. 28.2%, p = 0.030). Pandemic-related negative impact was associated with a greater demand for physician-provided information (p = 0.011). Conclusions: Pandemic-related healthcare experiences were associated with greater demand for physician-provided preventive information, while confirmed COVID-19 infection was more frequent among vaccinated participants. Positive vaccine-related beliefs and higher CD4+ T-cell counts were independently associated with vaccination uptake, while lack of physician recommendation remained a major barrier to vaccination. These findings emphasize the critical role of physicians in improving vaccination coverage among people living with HIV in the post-pandemic era.

Background: Early identification of patients at risk of severe COVID-19 is critical for timely interventions. We evaluated a biomarker-based risk stratification model, the Composite COVID-19 Biomarker Risk (CCBR) score, integrating age and inflammatory biomarkers (IL-6, PAI-1, LDH, neutrophil-to-lymphocyte ratio [NLR], and ferritin) measured at hospital admission to support early clinical risk assessment. Methods: In this retrospective single-center study, 235 hospitalized COVID-19 patients were classified into non-severe (n = 106) and severe (n = 129) groups. Biomarkers were measured within 24 h of admission. The CCBR score (0–6 points) was constructed by assigning one point to each parameter exceeding predefined cut-off values derived from published clinical thresholds and confirmed using receiver operating characteristic (ROC) curve analysis (Youden’s index). Patients were stratified into three risk categories: low risk (0–1 points), moderate risk (2–3 points), and high risk (4–6 points). Associations between CCBR scores and clinical outcomes, including severe disease, acute respiratory failure, dyspnea, complications, and antibiotic use, were assessed using logistic regression and ROC analyses. Internal validation was performed using split-sample validation and bootstrap resampling. Results: CCBR scores were significantly higher among patients with severe disease (p > 0.001). Each 1-point increase in CCBR was associated with a 6.78-fold increase in the odds of severe disease (OR = 6.78, p < 0.001). ROC analysis demonstrated moderate to good discriminative performance for severe disease (AUC = 0.714) and acute respiratory failure (AUC = 0.751). Conclusions: The CCBR score represents a simple biomarker-based model integrating inflammatory and endothelial dysfunction markers for early stratification of COVID-19 severity. This approach may assist clinicians in identifying patients at higher risk of severe disease and acute respiratory failure early during hospitalization.

Abnormal liver function tests are frequently reported in patients with COVID-19. This study aimed to identify potential treatment-associated hepatocellular injury in COVID-19 patients by dynamically assessing circulating miR-122, a biomarker with high hepatic specificity and sensitivity. An exploratory approach was additionally used, given the limited evidence regarding factors influencing miR-122 expression in this setting. We performed a prospective cohort study including 96 adult participants enrolled at a tertiary hospital in Bucharest, Romania, between March 2022 and July 2023: 78 COVID-19 patients (57 with baseline and follow-up miR-122 assessment after 5 days of treatment and 21 with a single measurement) and 18 non-COVID-19 participants included for comparison. Plasma miR-122 levels were measured using quantitative polymerase chain reaction, normalized to U6 small nuclear RNA, and expressed as log₁₀(2^−ΔCt). No associations were observed between miR-122 expression and remdesivir administered for standard treatment durations (3–5 days) or other COVID-19–specific therapies. However, a duration-dependent relationship with remdesivir cannot be excluded. Moreover, therapeutic paracetamol use prior to presentation was positively associated with miR-122 expression at follow-up and remained significant after adjustment. Additionally, bivariate analyses revealed inverse correlations between baseline miR-122 and inflammatory biomarkers, with multivariable analysis showing an independent positive association with lymphocyte count.

Background/Objectives: This study presents a comprehensive and updated epidemiological and public health assessment of human immunodeficiency virus (HIV) in Romania during 2022–2024, situated within the wider European context. Methods: For this retrospective descriptive study, we analyzed national surveillance data from the National Institute of Infectious Diseases “Prof. Dr. Matei Balș” and European Centre for Disease Prevention and Control (ECDC) reports, between 1985–2024, focusing especially on 2022–2024 period. Key indicators included incidence, mortality, transmission routes, age and gender distribution, and treatment coverage. Comparative analyses were performed between Romania and European Union (EU)/Eastern Europe data. Results: Between 1985 and 2024, Romania registered a cumulative total of 28,793 HIV cases, with 18,768 individuals living with HIV (PLHIV) as of 2024. In that year, 810 new HIV cases were diagnoses, indicating a modest uptick compared with 2022–2023. Heterosexual transmission continued to predominate (59.4%), followed by cases among men who have sex with men (MSM) (30.5%) and intravenous drug users (IDUs) (5.2%). Men represented more than three-quarters of all new infections. Mortality displayed considerable year-to-year variability, increasing from 125 HIV-related deaths in 2023 to 193 in 2024. Despite this, treatment coverage improved steadily, with 16,464 individuals receiving antiretroviral therapy (ART) by the end of 2024. At 2.51 cases per 100,000 population, Romania’s incidence remained below the European average of 3.5 per 100,000. Nonetheless, the proportion of infections attributable to MSM transmission rose sharply—from 3.91% in 2007 to 32% in 2024—bringing Romania’s epidemiological profile increasingly in line with broader trends observed in Eastern Europe. Conclusions: These findings suggest that although Romania maintains a comparatively lower HIV incidence than the European average, the evolving transmission dynamics—most notably the substantial increase in MSM-related cases—signal a shifting epidemiological landscape that warrants strengthened, population-specific prevention measures and continued investment in comprehensive treatment and monitoring frameworks.

Background/Objectives: Human Immunodeficiency Virus (HIV) remains a major public health concern globally and across Europe. Romania’s epidemic has historically followed unique patterns, particularly due to pediatric infections in the late 1980s, but has since evolved to mirror broader European trends. This study provides an updated epidemiological and public health perspective on HIV in Romania compared with Europe, focusing on 2022–2024. Methods: We analyzed national surveillance data from the National Institute of Infectious Diseases “Prof. Dr. Matei Balș” and European Centre for Disease Prevention and Control (ECDC) reports. Key indicators included incidence, mortality, transmission routes, age and gender distribution, and treatment coverage. Comparative analyses were performed between Romania and European Union (EU)/Eastern Europe data. Results: Between 1985 and 2024, Romania registered 28,793 HIV/AIDS cases, with 18,768 people currently living with HIV/AIDS. In 2024, 810 new cases were reported, reflecting a slight increase from 2022–2023. Heterosexual transmission remained predominant (59.4%), followed by MSM (30.5%) and IDU (5.2%). Men accounted for over 75% of new diagnoses. Mortality fluctuated, with 193 HIV/AIDS-related deaths in 2024, compared to 125 in 2023. Despite this, treatment coverage improved, with 16,464 patients on ART by the end of 2024. Compared with Europe, Romania’s incidence (2.51/100,000) remained below the continental average (3.5/100,000), though MSM-related transmission rose sharply, aligning with Eastern European patterns. Conclusions: Romania has made significant progress in HIV care and treatment access, transforming HIV into a manageable chronic condition. However, persistent challenges include the rising burden among MSM, fluctuating mother-to-child transmission, and enduring stigma. Strengthened prevention strategies, expanded testing, and targeted interventions are essential to align Romania with successful European models and sustain progress toward HIV elimination.

Background and Objectives: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel biomarkers that provide insight into systemic inflammation and how the immune system responds to stress or infection. These ratios have been associated with predicting clinical outcomes in various diseases, including COVID-19. This study aims to evaluate the prognostic value of NLR and PLR in anticipating ICU admission, acute respiratory failure, and disease severity in COVID-19 patients. Materials and Methods: We conducted a retrospective, observational study that included 536 patients diagnosed with COVID-19. We analyzed the NLR and PLR values at admission and correlated them with ICU admission, the onset of acute respiratory failure, and clinical outcomes. Results: Statistical correlations were identified between elevated NLR and PLR values and the development of complications during hospitalization (p = 0.04 and p = 0.00), acute hypoxemic respiratory failure (p = 0.00), and admission to the intensive care unit (ICU) (p = 0.04). No correlations were found between the values of these ratios and mortality (p = 0.46 and p = 0.32) nor with the development of hepatic cytolysis (p = 0.79 and p = 0.87). Conclusions: NLR and PLR are reliable, easily obtainable biomarkers that can aid in the early prediction of ICU admission and disease severity in COVID-19 patients, offering valuable insights for risk stratification and clinical management. Further prospective studies are needed to validate these biomarkers as part of a broader predictive model for critical care in COVID-19.

Background: COVID-19 has largely become an endemic disease in many regions, with sporadic outbreaks, with some areas where the disease shows a seasonal pattern like the influenza virus. The focus has shifted towards managing mild and moderate forms of disease through outpatient care, aiming to prevent healthcare system overload. Consequently, identifying markers that could be used in stratifying the risk and the prognostic assessment has become crucial. Cardiovascular implications of COVID-19 are a critical area of research due to their significant impact on disease severity, mortality, and morbidity. Methods: We conducted a retrospective, observational study and included 472 patients, diagnosed with COVID-19, all of whom were admitted to Prof. Dr. Matei Bals National Institute of Infectious Disease, Bucharest, Romania. Levels of cardiac biomarkers like creatine kinase (CK), creatine kinase-myocardial band (CKMB), myoglobin, troponins, and NT-pro-BNP were measured and analyzed in relation to clinical presentation and outcomes. Results: We combined CKMB, myoglobin, and troponin I to predict hospital length of stay (LOS). Our model significantly predicted LOS (F = 12.537, p = 0.0001), with higher levels associated with prolonged stays (β = 0.166, p = 0.000). Logistic regression demonstrated that the combination of elevated CKMB and myoglobin levels significantly increased the odds of a longer LOS (OR = 1.679, p = 0.000). Furthermore, we found significant correlations with acute respiratory failure (p = 0.001), severe forms of disease (p = 0.000), and the development of complications during hospitalization (p = 0.027). Conclusions: These findings emphasize the value of combining cardiac biomarkers to stratify risk and predict hospital outcomes in COVID-19 patients. Routine cardiac monitoring and targeted management strategies could decrease the risk of complications, reducing the LOS. Our findings highlight the potential of cardiac biomarkers as prognostic tools to stratify risk, guide clinical interventions, and improve outcomes in COVID-19 patients.

Objectives: This study aimed to evaluate the risk of hepatitis B virus reactivation (HBVr) in COVID-19 patients receiving immunosuppressive treatment, which has been insufficiently studied to date. Secondarily, we aimed to evaluate the seroprevalence of HBV infection in COVID-19 patients. Methods: We performed HBV screening on all Romanian adults hospitalized in four COVID-19 wards between October 2021 and September 2022. We enrolled patients with positive hepatitis B core antibody (anti-HBc) without protective hepatitis B surface antibody (anti-HBs), HBV treatment, or baseline immunosuppressive conditions, and we conducted a virological follow-up on these patients at 3 months. Results: We identified 333/835 (39.9%) anti-HBc-positive patients. Follow-up was performed for 13 patients with positive hepatitis B surface antigen (HBsAg) and 19 HBsAg-negative/anti-HBc-positive patients. Among those who received immunosuppressants, 4/23 (17.4%) patients experienced HBVr: 1 out of 8 (12.5%) HBsAg-positive patients (with 1.99 log increase in HBV DNA level) and 3 out of 15 (20%) HBsAg-negative/anti-HBc-positive patients (with a de novo detectable HBV DNA level). Conclusions: Administration of COVID-19 immunosuppressants may result in a significant risk of HBVr in co-infected patients. We recommend performing an HBV triple screen panel (HBsAg, anti-HBs, anti-HBc) for all COVID-19 patients receiving immunosuppressive treatment. HBV prophylaxis may be indicated in certain patients. Larger studies are needed in order to establish appropriate and cost-effective management for these patients.

Objectives: This study aimed to evaluate the risk of hepatitis B virus reactivation (HBVr) in COVID-19 patients receiving immunosuppressive treatment, which has been insufficiently studied to date. Secondarily, we aimed to evaluate the seroprevalence of HBV infection in COVID-19 patients. Methods: We performed an HBV screening in all Romanian adults hospitalized in 4 COVID-19 wards between October 2021 and September 2022. We enrolled patients with positive hepatitis B core antibody (anti-HBc) without protective hepatitis B surface antibody (anti-HBs), HBV treatment or immunosuppressive conditions, whom we followed virologically at 3 months. Results: We identified 333/835 (39.9%) anti-HBc-positive patients. Follow-up was performed in 13 patients with positive hepatitis B surface antigen (HbsAg) and 19 HBsAg-negative/anti-HBc-positive patients. Among those who received immunosuppressants, 4/23 (17.4%) patients experienced HBVr: 1 out of 8 (12.5%) HBsAg-positive patients (with 1.99 log increase in HBV DNA level) and 3 out of 15 (20%) HBsAg-negative/anti-HBc-positive patients (with de novo detectable HBV DNA level). Conclusions: Administration of COVID-19 immunosuppressants may result in a significant risk of HBVr in co-infected patients. We recommend performing an HBV triple screen panel (HBsAg, anti-HBs, anti-HBc) in all COVID-19 patients receiving immunosuppressive treatment. HBV prophylaxis may be indicated in certain patients. Larger studies are needed in order to establish an appropriate and cost-effective management in these patients.